BMJ, doi:10.1136/bmj.39304.464016.AE (published 11 September 2007)
Research
Effect of prolonged and exclusive breast feeding on risk of allergy and
asthma: cluster randomised trial
Michael S Kramer, James McGill professor; and scientific director1, Lidia
Matush, chief2, Irina Vanilovich, senior scientist3, Robert Platt, associate
professor; and investigator and associate director4, Natalia Bogdanovich,
senior scientist3, Zinaida Sevkovskaya, senior scientist3, Irina Dzikovich,
senior scientist3, Gyorgy Shishko, director3, Bruce Mazer, associate
professor; and head5 
1 Departments of Pediatrics and of Epidemiology and Biostatistics, McGill
University Faculty of Medicine; and Institute of Human Development and Child
and Youth Health, Canadian Institutes of Health Research (CIHR), Montreal,
Canada, 2 Maternal and Child Health Department, Belarussian Ministry of
Health, 3 Belarussian Maternal and Child Health Research Institute, 4
Departments of Pediatrics and of Epidemiology and Biostatistics, McGill
University; and IS/IT, McGill University Health Centre Research Institute,
Montreal, 5 Department of Pediatrics, McGill University; and Division of
Pediatric Allergy and Clinical Immunology, Montreal Children's Hospital,
McGill University Health Centre 
Correspondence to: M S Kramer, Montreal Children's Hospital, 2300 Tupper
Street (Les Tourelles), Montreal, Quebec H3H 1P3  [log in to unmask] 
Objective To assess whether exclusive and prolonged breast feeding reduces
the risk of childhood asthma and allergy by age 6.5 years. 
Design Cluster randomised trial. 
Setting 31 Belarussian maternity hospitals and their affiliated polyclinics.

Participants A total of 17 046 mother-infant pairs were enrolled, of whom 13
889 (81.5%) were followed up at age 6.5 years. 
Intervention Breastfeeding promotion intervention modelled on the WHO/UNICEF
baby friendly hospital initiative. 
Main outcome measures International study of asthma and allergies in
childhood (ISAAC) questionnaire and skin prick tests of five inhalant
antigens. 
Results The experimental intervention led to a large increase in exclusive
breast feeding at 3 months (44.3% v 6.4%; P<0.001) and a significantly
higher prevalence of any breast feeding at all ages up to and including 12
months. The experimental group had no reduction in risks of allergic
symptoms and diagnoses or positive skin prick tests. In fact, after
exclusion of six sites (three experimental and three control) with
suspiciously high rates of positive skin prick tests, risks were
significantly increased in the experimental group for four of the five
antigens. 
Conclusions These results do not support a protective effect of prolonged
and exclusive breast feeding on asthma or allergy. 
Trial registration Current Controlled Trials ISRCTN37687716
[controlled-trials.com] . 
Related Articles
CONSORT statement: extension to cluster randomised trials 
Marion K Campbell, Diana R Elbourne, and Douglas G Altman
BMJ 2004 328: 702-708. [Extract] [Full Text] 
Association between breast feeding and asthma in 6 year old children:
findings of a prospective birth cohort study 
W H Oddy, P G Holt, P D Sly, A W Read, L I Landau, F J Stanley, G E Kendall,
and P R Burton
BMJ 1999 319: 815-819. [Abstract] [Full Text] 


Esther G

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